Effects of cyclic adenosine monophosphate modulating agents during oocyte pre-maturation and the role of melatonin on in vitro maturation of bovine cumulus-oocyte complexes.

This study investigated the effects of cyclic adenosine monophosphate modulating during cumulus-oocyte complexes (COCs) pre-maturation and the role of melatonin on in vitro maturation (IVM) of bovine COCs. In experiment one, COCs were pre-matured for 8 h in control medium or with 3-isobutyl-1-methylxanthine (IBMX) and forskolin, IBMX and C-type natriuretic peptide, c-type natriuretic peptide and forskolin or IBMX, forskolin and c-type natriuretic peptide. Then, meiotic progression was evaluated. In experiment two, COCs were pre-matured, followed by IVM in control medium alone or with 10-6, 10-7 or 10-8 M melatonin. After IVM, chromatin configuration, transzonal projections (TZPs), reactive oxygen species, mitochondrial distribution, ultrastructure and mRNA expression for antioxidant enzymes were evaluated. In experiment 1, COCs pre-matured with both C-type natriuretic peptide and forskolin or C-type natriuretic peptide, forskolin and IBMX had lower meiotic resumption rate when compared to control. Considering that IBMX had not an additional effect to potentiate inhibition of meiotic resumption, a combination of C-type natriuretic peptide and forskolin was chosen. In experiment 2, COCs matured with 10-8 M melatonin had greater rates of meiotic resumption when compared to the other treatments (P < 0.05). The COCs matured with 10-7 or 10-8 M melatonin had greater mitochondrial activity (P < 0.05), while those matured with 10-6 or 10-8 M of melatonin had greater levels of TZPs. Ultrastructure of oocyte and cumulus cells after IVM with melatonin was relatively well preserved. COCs matured with 10-8 M melatonin increased mRNA expression for superoxide dismutase (SOD) and catalase (CAT) (P < 0.05), when compared to non-cultured and pre-matured COCs, respectively. In conclusion, bovine COC pre-maturation with C-type natriuretic peptide and forskolin, followed by IVM with 10-8 M melatonin improves meiotic resumption rates, TZPs, mitochondrial distribution and mRNA expression for SOD and CAT.

Vosoritide para acondroplasia con epífisis abierta / Vosoritide for achondroplasia with epiphysis open

INTRODUCCIÓN: La acondroplasia es la causa más común de baja estatura desproporcionada. Es causada por una mutación patogénica en el gen del receptor 3 del factor de crecimiento de fibroblastos (FGFR3, siglas del inglés Fibroblast Growth Factor Receptor 3), que codifica un receptor transmembrana importante en la regulación del crecimiento lineal de los huesos largos. Esto resulta en una alteración de la osificación endocondral, provocando un crecimiento desproporcionado, donde el crecimiento del tronco no se ve tan gravemente afectado como el de las extremidades y el cráneo. En el 80% de los casos es producida por una mutación genética de novo, siendo de herencia autosómica dominante. Cuando ambos padres tienen acondroplasia, la probabilidad de que cada uno de sus futuros hijos pueda tener una estatura promedio es del 25%, tener acondroplasia es del 50% y finalmente tener acondroplasia homocigota (que suele ser letal) es del 25%. La acondroplasia afecta el crecimiento de casi todos los huesos del cuerpo, incluidos el cráneo, la columna vertebral, los brazos y las piernas, lo que da como resultado una estatura muy baja con una apariencia característica: acortamiento predominantemente proximal (humero, fémur) de los huesos largos de las extremidades (rizomelia); de los dedos de las manos secundario a huesos metacarpianos cortos (braquidactilia), cifosis (deformidad convexa de la unión torácica-lumbar), compresión cervicomedular (debido al estrechamiento en la parte superior de la columna secundario al estrechamiento del foramen magnum); macrocefalia y rasgos faciales caracterizado por prominencia frontal y retrusión del tercio medio facial. Las personas afectadas pueden sufrir alguna de las complicaciones adicionales: hidrocefalia; estenosis del canal vertebral (pacientes después de su segunda o tercera década de vida); obstrucción de la vía aérea superior/apnea obstructiva del sueño (secundario a la reducción del espacio de las vías respiratorias por la retrusión de la parte media de la cara junto con el agrandamiento de adenoides y amígdalas); deformidades óseas (genu varum: desviación hacia afuera debido al arqueamiento); malformación de Arnold-Chiari; microftalmos, y disfunción del oído medio, obesidad, hipertensión arterial, problemas de movilidad, dolor crónico y baja actividad física. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad, aspectos económicos, recomendaciones de sociedades científicas y las políticas de cobertura (PC) para el uso del vosoritide para personas con acondroplasia y epífisis abierta. DESCRIPCIÓN DE LA TECNOLOGÍA: El vosoritide (BMN 111) es un péptido natriurético humano tipo C recombinante modificado que es producido en células de Escherichia coli mediante tecnología de ADN recombinante. En los pacientes con acondroplasia, el gen FGFR3 que regula el crecimiento está "activado" permanentemente, impidiendo el crecimiento normal de los huesos por lo que terminan siendo más cortos de lo habitual.33 Vosoritide actúa uniéndose a un receptor denominado receptor del péptido natriurético tipo B, que reduce la actividad de FGFR3, y esto, promueve la proliferación y diferenciación de condrocitos y el crecimiento óseo endocondral. MÉTODOS: Las búsquedas se llevaron a cabo en las principales bases de datos bibliográficas: PUBMED, CRD (Centre for Reviews and Dissemination), Cochrane, TRIPdatabase (TRIP: Turning Research Into Practice), Epistemonikos, BRISA (Base Regional de Informes de Evaluación de Tecnologías en Salud de las Américas), LILACS (Literatura Latinoamericana y del Caribe en Ciencias de la Salud), INAHTA (International Network of Agencies for Health Technology Assessment), PROSPERO (International Prospective Register Of Systematic Reviews), en buscadores genéricos de internet y en sitios web de financiadores de salud. Se realizó una búsqueda sistemática de información publicada con fecha límite hasta el 29 de junio sobre el uso del vosoritide en pacientes con Acondroplasia y epífisis abierta. Se priorizó para la búsqueda inicial, la identificación de Revisiones Sistemáticas (RS) y Metaanálisis (MA), Evaluaciones de Tecnologías Sanitarias (ETS), Evaluaciones Económicas (EE), Guías de Práctica Clínica (GPC), políticas de cobertura (PC) de diferentes sistemas de salud y ensayos clínicos aleatorizados (ECA), se realizó una búsqueda con los filtros metodológicos correspondientes. RESULTADOS: Como resultado de la búsqueda bibliográfica, se recuperaron 12 estudios: ocho en curso, cuatro finalizados (estudio 111-101 [NCT01590446], estudio 111-202 [NCT02055157], Savarirayan y cols. 2020 [111-301, NCT03197766] y Savarirayan y cols. 2021 [111-302, NCT03424018]; tres Evaluaciones de Tecnologías Sanitarias (ETS); una revisión sistemática en curso; cinco Guías de Práctica Clínica (GPC) / Consensos / Recomendaciones. No se han hallado estudios primarios con comparación "cabeza-cabeza" entre el vosoritide versus cirugía de alargamiento u hormona de crecimiento. CONCLUSIONES: Al momento, no está autorizada su comercialización en Argentina, pero está en evaluación por el Registro de Especialidades Médicas. No se han encontrado estudios primarios con comparación "cabeza-cabeza" entre el vosoritide versus cirugía de alargamiento u hormona de crecimiento. No se recuperó evidencia relacionado con la tasa de complicaciones graves como: estrechez de la unión cérvico-medular; macrocefalia/hidrocefalia; estenosis del canal vertebral; obstrucción de la vía aérea superior; deformidades óseas; malformación de Arnold-Chiari; microftalmos. No hubo diferencias clínicamente significativas en la calidad de vida relacionada con la salud, ni tampoco en la independencia funcional para vosoritide frente a placebo en personas de 5 a 18 años de edad con acondroplasia y epífisis abierta (certeza alta ⨁⨁⨁⨁). Aumenta la velocidad de crecimiento anualizada (1,57 cm/año más alto), aunque se desconoce si se sostiene en el tiempo para vosoritide frente a placebo en personas de 5 a 18 años de edad con acondroplasia y epífisis abierta (certeza alta ⨁⨁⨁⨁). Aumenta la puntuación Z a 52 semanas de seguimiento (cambio medio de mínimos cuadrados 0.28 más alto), aunque se desconoce si se sostiene en el tiempo, para vosoritide frente a placebo en personas de 5 a 18 años de edad con acondroplasia y epífisis abierta (certeza alta ⨁⨁⨁⨁). No hay diferencias en la proporción de segmentos corporales superiores e inferiores entre el inicio y el final de seguimiento, para vosoritide frente a placebo en personas de 5 a 18 años de edad con acondroplasia y epífisis abierta (certeza alta ⨁⨁⨁⨁). Si bien probablemente no aumente el riesgo de eventos adversos serios, y aumenta el riesgo de cualquier evento adverso (certeza alta ⨁⨁⨁⨁). No se recuperaron Guías de Práctica Clínica que recomienden su utilización y la mayoría de las políticas de cobertura relevadas no la mencionan en la indicación evaluada. Si bien no existen evaluaciones económicas locales, se estima que podría ser NO costoefectiva en Argentina. Se estimó que el impacto en términos de costo de oportunidad requeriría sumar 32.870 gastos en salud per cápita por año, o limitaría el pago de 1.232 haberes jubilatorios mínimos anuales.

Vosoritide en acondroplasia / Vosoritide in achondroplasia

CONTEXTO: La acondroplasia es la displasia ósea más frecuente, se caracteriza por un fallo en la formación normal del cartílago en hueso, lo que da lugar a una estatura desproporcionada. Se trata de un transtorno genético, de herencia autosómico dominante, de penetrancia completa, se produce por mutaciones en el gen del receptor del factor de crecimiento de fibroblastos 3 (FGFR3). El 80% de las mutaciones se producen de novo, y por lo tanto estos pacientes tienen padres de estatura media. Los pacientes que han heredado el gen defectuoso de ambos padres son los más afectados y normalmente mueren a pocos días del nacimiento o unos meses después. Se estima que afecta a 250.000 individuos em todo el mundo. El FGFR3 es uno de los cuatro receptores del factor de crecimiento de fibroblastos en humanos, se ubican en la superficie celular e influyen en su proliferación. La acción del FGFR3 es de regulador negativo del crecimiento óseo condrocitario. La mutación que da lugar a la acondroplasia, es uma mutación de ganancia de función, generando una señal inhibidora.2 Esta activación permanente de la señalización del FGFR3 acciona dos cascadas de señalización intracelular que llevan a menor proliferación y diferenciación de los condrocitos de la placa de crecimiento óseo, a través de la vía STAT-1, y a una menor producción de la matriz extracelular a través de la vía MAPK, por estos dos mecanismos el crecimiento del hueso se enlentece. TECNOLOGÍA: El vosoritide es un análogo del péptido natriuretico tipo C (CNP, de sus siglas en inglés C type Natriuretic Peptide), actúa uniéndose al receptor del péptido natriuretico tipo B (NPR-B, de sus siglas en inglés natriuretic receptor type-B), el cual induce la inhibición de la vía MAPK. La inhibición de esta vía lleva a un incremento en la producción de la matriz extracelular estimulando la proliferación de los huesos. Se indica en una dosis de 15 mcg/Kg, una vez por día por vía subcutánea rotando el sitio de inyección. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura del uso de vosoritide en pacientes con acondroplasia. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron dos ECAs y una evaluación de tecnología sanitaria para el uso de vosoritide en acondroplasia. CONCLUSIONES: Evidencia de baja calidad muestra que el uso de vosoritide para pacientes acondroplasicos con placas de crecimiento abiertas produce un aumento en la velocidad de crecimiento aunque se desconoce la eficacia en cuanto a que este aumento de la velocidad de crecimiento se sostenga en el tiempo y conlleve a mejoras en la sobrevida y/o calidad de vida. No se han encontrado guías de práctica clínica que mencionen esta tecnología para el tratamento de la acondroplasia. Así como tampoco, financiadores internacionales que den cobertura para vosoritide en esta condición. Hasta la fecha, no está autorizada su comercialización en Estados Unidos, pero si fue aprobada recientemente en Europa. En Argentina se encuentra en fase de evaluación por el ANMAT por lo que todavía no está aprobada su comercialización. No se encontraron evaluaciones económicas locales, ni internacionales acerca de la costo-efectividad del vosoritide para esta indicación. Si bien no existe esta evidencia de sobre la costo-efectividad; se podría estimar que el uso del vosoritide no sería costo-efectivo en la Argentina, dada la relación entre el costo de la intervención y el tamaño del potencial beneficio neto.

Influence of cAMP modulator supplementation of in vitro culture medium on Bos taurus indicus embryos.

The effectiveness of the use of natriuretic peptide C (NPPC) in the blocking of meiosis has already been proven in several species. However, there are no reports on the use of NPPC in the activation of metabolic processes in embryos. Whereas modulations of cAMP concentrations alter the lipid metabolism of bovine oocytes, the present study aims to evaluate the effect of NPPC on the development, lipid content and transcript levels of genes related to lipid metabolism of IVP bovine embryos. For this purpose, ovaries were obtained from a slaughterhouse, and oocytes were fertilized in vitro (D0). From D5 of in vitro culture, embryos were treated with 100 nM NPPC (NPPC group) or with no NPPC (Control group) and evaluated in terms of Blastocyst (D7) and hatching rates (D10). For the assessment of the cytoplasmatic lipid amounts, blastocysts were stained with Sudan Black B dye. The embryonic lipid profile was investigated by electrospray ionization desorption-mass spectrometry (DESI-MS). The abundance of nine transcripts related to lipid metabolism were assessed using the Biomark HD system. For statistical analysis, blastocyst and hatching rates, lipid content by the Sudan Black B and variation of gene expression between groups were compared by Student t-test. For lipid profile analysis, principal component analysis (PCA) and fold-change were performed. The embryo lipid content was similar between NPPC (881 ±â€¯3.7) and Control (883 ±â€¯5.2) groups (p > 0.05). However, cholesteryl esters and TAGs were downregulated by NPPC at multiple levels according to the DESI-MS profiles. Of the analyzed genes, ELOVL6 and SREBF1 showed an up-regulation in the control group (p < 0.05), while CPT2 was observed to be up-regulated in the NPPC-treated embryos. There was no significant difference in the blastocyst production rate between NPPC (44.4%) and Control (42.4%), however the hatching rate at D10 was higher (p < 0.05) in the NPPC group (69.77%) when compared to the Control group (48.33%). These findings demonstrate that NPPC alters the mRNA expression of genes related to lipid metabolism and that it exerts a positive effect on the hatching rates of IVP Bos taurus indicus embryos.

NO mediates the effect of the synthetic natriuretic peptide NPCdc on kidney and aorta in nephrectomised rats.

NPCdc is a synthetic natriuretic peptide that was originally derived from another peptide, the NP2_Casca, isolated from Crotalus durissus cascavella venom. These molecules share 70% structural homology with natriuretic peptides obtained from different species, including humans. NP2_Casca induces vasorelaxation and increases nitric oxide levels independently of natriuretic peptide receptors A and B. This study aimed to investigate whether NPCdc-induced hypotension in control rats and rats with a reduced kidney mass is associated with effects on the glomerular filtration rate, NADPH oxidase activity and components downstream of natriuretic peptide receptor C (NPR-C). Anaesthetized Wistar rats that were subjected to a sham operation and 5/6 nephrectomy (5/6Nx) were infused with saline (vehicle) or NPCdc (7.5 µg/kg/min) for 70 min. The NPCdc treatment decreased the mean arterial pressure and NADPH oxidase activity while simultaneously increasing the glomerular filtration rate, fractional Na+ excretion and nitric oxide level. After 70 min, the levels of p-AKT Ser-473, p-eNOS Ser-1177, p-nNOS Ser-1417 and p-iNOSTyr-151 were not affected. However, p-ERK1/2 Thr-202/Tyr-204 levels were altered. Thus, nitric oxide and components of NPR-C signalling mediate the effects of NPCdc. The results suggest a potential therapeutic application of this peptide for cardiorenal syndrome.

Chronic treatment with C-type natriuretic peptide impacts differently in the aorta of normotensive and hypertensive rats.

The aim of this study was to determine whether exogenous administration of C-type natriuretic peptide (CNP) induces functional and morphological vascular changes in spontaneously hypertensive rats (SHR) compared with normotensive rats. Male 12-week-old normotensive Wistar and SHR were administered with saline (NaCl 0.9%) or CNP (0.75 µg/h/100 g) for 14 days (subcutaneous micro-osmotic pumps). Systolic blood pressure (SBP) was measured in awake animals and renal parameters were evaluated. After decapitation, the aorta was removed, and vascular morphology, profibrotic markers, and vascular reactivity were measured. In addition, nitric oxide (NO) system and oxidative stress were evaluated. After 14-days of treatment, CNP effectively reduced SBP in SHR without changes in renal function. CNP attenuated vascular remodeling in hypertensive rats, diminishing both profibrotic and pro-inflammatory cytokines. Also, CNP activated the vascular NO system and exerted an antioxidant effect in aortic tissue of both groups, diminishing superoxide production and thiobarbituric acid-reactive substances, and increasing glutathione content. These results show that chronic treatment with CNP attenuates the vascular damage development in a model of essential hypertension, inducing changes in fibrotic, inflammatory, oxidative, and NO pathways that could contribute to beneficial long-term effects on vascular morphology, extracellular matrix composition, and function. The knowledge of these effects of CNP could lead to improved therapeutic strategies to not only control BP but also reduce vascular damage, primarily responsible for the risk of cardiovascular events.

C-type natriuretic peptide signaling in human follicular environment and its relation with oocyte maturation.

Studies in mice have shown that C-type natriuretic peptide (CNP) is produced by granulosa cells and contributes to ovarian follicle growth and oocyte meiotic arrest until the preovulatory LH surge. In humans, the relationship between intraovarian CNP levels and oocyte meiotic resumption is unknown. The aim of this study was to investigate whether CNP and its receptor NPR2 are expressed in human ovarian follicles and if their levels change according to the meiotic phase of oocytes. We collected follicular fluid (FF) and luteinized granulosa cells (LGC) from follicle pools (n = 47), and FF, LGC and cumulus cells (CC) from individual follicles (n = 96) during oocyte pickup for in vitro fertilization. There was a positive linear correlation between CNP levels in FF pools and basal antral follicle counting (rs = 0.458; p = 0.002), number of preovulatory follicles >16 mm (rs = 0.361; p = 0.016) and number of oocytes retrieved (rs = 0,378; p = 0.011) and a negative correlation between CNP levels in FF pools and the percentage of mature (MII) oocytes retrieved (rs = -0.39; p = 0.033). FF CNP levels in follicles containing MII oocytes were significantly lower than in follicles containing immature (MI) oocytes (median = 0.44 vs. 0.57 ng/mL, p < 0.05). Accordingly, the CNP precursor gene NPPC was 50% less expressed in LGC from follicles containing MII oocytes than in follicles containing MI oocytes (p < 0.01). In addition, NPR2 mRNA was down-regulated in CC surrounding MII oocytes (60% reduction, p < 0.01). CNP signaling is downregulated in human ovarian follicles containing mature oocytes. Further studies should clarify whether CNP signaling is essential to keep oocyte meiotic arrest in humans.

C-type natriuretic peptide: a link between hyperandrogenism and anovulation in a mouse model of polycystic ovary syndrome.

The polycystic ovary (PCO) syndrome (PCOS) is the most common cause of anovulatory infertility in women and is associated with several clinical disorders. Despite the great amount of research in the area, mechanisms involved in the genesis of this syndrome remain poorly understood. In a recent issue of Clinical Science (vol. 132, issue 7, 759-776), Wang and colleagues, highlight the important role of overactivated C-type natriuretic peptide (CNP) and natriuretic peptide receptor 2 (CNP/NPR2) system in preventing oocyte maturation and ovulation in PCOS mice model induced by androgen. Dehydroepiandrosterone (DHEA) treatment caused anovulation, high levels of androgen and estrogen receptors (AR and ER) in the ovary, high expression of CNP and natriuretic peptide receptor 2 (NPR2) in granulosa cells (GC), and an increase in testosterone and estradiol (E2) levels in sera. The high level of CNP/NPR2 was associated with oocyte meiotic arrest and very low ovulation rate. Treatment with human chorionic gonadotropin (hCG) or inhibitors of AR or ER reduced the level of CNP/NPR2, which resulted in meiotic resumption and ovulation. The article provided important information for understanding the effect of ovarian steroids on control of oocyte maturation and fertility and highlighted CNP/NPR2 as a specific pathway that is potentially involved in the ovulatory disruption in PCOS.

O NT-ProBNP da admissão versus da alta como preditor prognóstico na insuficiência cardíaca Agudamente Descompensada / NT-ProBNP at Admission Versus NT-ProBNP at discharge as a prognostic predictor in acute decompensated heart failure

Fundamento: Pacientes internados por insuficiência cardíaca (IC) descompensada recebem intensa terapia diurética e vasodilatadora nos primeiros dias, conduta normalmente bem-sucedida na compensação do quadro, permitindo alta hospitalar. No entanto, é comum a recorrência de agravamento nas primeiras semanas após a alta. Objetivo: Avaliar se o principal preditor de recorrência de desfechos em pacientes com IC é o grau de descompensação na admissão ou o estado volêmico obtido após controle clínico. Métodos: coorte prospectiva de pacientes admitidos entre janeiro de 2013 e outubro de 2014, com diagnóstico de IC agudamente descompensada, acompanhados até 60 dias após a alta hospitalar. O critério de inclusão foi aumento da dosagem plasmática do NT-proBNP (> 450 pg/mL para pacientes abaixo de 50 anos ou NT-proBNP > 900 pg/mL para pacientes acima de 50 anos). O desfecho primário foi a combinação de óbito cardiovascular após compensação e reinternação por IC descompensada em 60 dias. Resultados: Foram estudados 90 pacientes, com mediana do NT-proBNP da admissão 3947 pg/mL (IIQ = 2370 pg/mL a 7000 pg/mL), mediana da variação absoluta do NT-proBNP de -1533 pg/mL (IIQ = -3569 pg/mL a 747 pg/mL), e mediana do NT-proBNP da alta de 1946 pg/mL (IIQ = 1000 pg/mL a 3781 pg/mL). A incidência do desfecho combinado foi de 30%, sendo 12,2% de óbitos e 20% de readmissão. A curva ROC do NT-proBNP da admissão e eventos cardiovasculares em 60dias apresentou uma área sob a curva de 0,49 (p = 0,89; IC 95% = 0,36 ­ 0,62). A variação absoluta do NT-proBNP apresentou área sob a curva de 0,65 (p = 0,04; IC 95% =0,51 ­ 0,79) para eventos em 60 dias, e o NT-proBNP da alta apresentou área sob a curva de 0,69 (p = 0,03; IC 95% = 0,58 ­ 0,80). Em análise multivariada, NT-proBNP que precedeu a alta foi preditor do desfecho primário, independente do valor mensurado na admissão e de outros fatores de risco. Conclusão: Diferente do grau de descompensação que motivou a internação, o estado volêmico obtido após compensação da IC se associa a eventos recorrentes. Este achado sugere que, independentemente da gravidade inicial, é a resposta ao tratamento durante o internamento que determina a vulnerabilidade do paciente para nova descompensação

Background: Patients admitted for decompensated heart failure (HF) receive intensive diuretic and vasodilator therapy in the first days. Normally, this is a successful approach that leads to HF compensation and hospital discharge. However, recurrences within the first week of discharge are common. Objective: to evaluate whether the main predictor of recurrent outcomes in patients with HF is the severity of decompensation at admission or patient's blood volume after clinical management. Methods: Prospective, cohort study of patients admitted between January 2013 and October 2014, with diagnosis of acute decompensated HF, who were followed-up for 60 days after discharge. Inclusion criterion was increased plasma NT-proBNP (> 450 pg/mL for patients younger than 50 years or >900pg/mL for patients older than 50 years). Primary outcome was the combination of cardiovascular death with rehospitalization for decompensated HF in 60 days. Results: Ninety patients were studied, with median NT-proBNP at admission of 3,947pg/mL (IQR: 2,370 ­ 7,000 pg/mL), and median NT-proBNP at discharge of 1,946pg/mL (IQR: 1,000 ­ 3,781 pg/mL). The incidence of combined outcome was 30% (12.2% of deaths and 20% of rehospitalization). The area under the ROC curve for NT-proBNP at admission and 60-day cardiovascular events was 0.49 (p = 0.89; 95% CI = 0.36 ­ 0.62). The area under the curve of NT-proBNP absolute variation for 60 day-events was 0.65 (p = 0.04; 95%CI = 0.51 ­ 0.79), and the area under the curve for NT-BNP at discharge was 0.69 (p = 0.03; 95%CI = 0.58 ­ 0.80). In the multivariate analysis, pre-discharge NT-proBNP was a predictor of the primary outcome, independently of the NT-proBNP at admission and other risk factors. Conclusion: Different from the severity of decompensation at hospitalization, blood volume after compensation of HF is associated with recurrent event. This finding suggests that, regardless of initial severity, therapy response during hospitalization is determinant of the risk of recurrent decompensation

Androgen receptor is expressed in mouse cardiomyocytes at prenatal and early postnatal developmental stages.

BACKGROUND: Previous studies show that androgens are involved in hypertrophy and excitability of cardiomyocytes and that their effects are mediated through their receptor. The aim of this study was to evaluate the presence of androgen receptor (AR) in mouse heart during prenatal and early postnatal stages. RESULTS: The expression of AR and related genes, alpha myosin heavy chain -Myh6-, beta myosin heavy chain -Myh7- and atrial natriuretic factor -Nppa- was simultaneously evaluated by semiquantitative RT-PCR. AR was also detected by immunohistochemistry. Androgen receptor mRNA was detected in hearts from 10.5 days post coitum to 16 postnatal days. A higher expression of AR mRNA in atria compared to ventricles was observed in neonatal mouse. A positive correlation between mRNA levels of AR and Nppa was observed in mouse heart at early postnatal development. Androgen receptor expression is similar in males and females during cardiac development. Finally, androgen receptor protein was observed by immunohistochemistry in myocardial cells of atria and ventricles from 12.5 days onwards and restricted after 16.5 days post-coitum to nuclei of cardiomyocytes. CONCLUSION: Present results provide evidence that androgen receptor is expressed from prenatal stages in mouse heart, supporting the proposition that androgens could be involved in mammalian heart development.

Steroid hormones interact with natriuretic peptide C to delay nuclear maturation, to maintain oocyte-cumulus communication and to improve the quality of in vitro-produced embryos in cattle.

In vivo, oocyte maturation is triggered by the ovulatory LH surge, whereas in vitro it is precociously induced when the cumulus-oocyte complex is removed from the follicle. Natriuretic peptide C (NPPC) delays germinal vesicle breakdown (GVBD) while increasing oocyte-cumulus communication during in vitro maturation (IVM) in cattle. In the present study we first tested the hypothesis that steroids secreted by the follicle (17ß-oestradiol, progesterone and androstenedione) interact with NPPC to delay GVBD and to maintain oocyte-cumulus communication as assessed by transfer of a dye (Lucifer Yellow) from the oocyte to cumulus cells. Then, we assessed the effects of steroid hormones and NPPC, alone and in combination in a pre-IVM culture, on embryo production. The combination of NPPC with steroids delayed GVDB, increased natriuretic peptide receptor 2 (NPR2) mRNA abundance in cumulus cells during culture, and maintained oocyte-cumulus communication at levels not different from non-cultured controls. The addition of steroids and/or NPPC to a pre-IVM culture did not alter blastocyst rates after IVF, but supplementation with steroids increased blastocyst total cell number. The present study provides evidence, for the first time in cattle, that steroids interact with NPPC to regulate oocyte nuclear maturation and oocyte-cumulus communication, and improve oocyte developmental competence.

Meiotic arrest as an alternative to increase the production of bovine embryos by somatic cell nuclear transfer.

This study aimed to evaluate the effect of meiotic arrest using phosphodiesterase type 3A (PDE 3A) inhibitors, cilostamide and C-type natriuretic peptide (NPPC), on pre-maturation (PM) of oocytes to be used in the production of cloned embryos. Nuclear maturation, in vitro embryo production (IVP), somatic cell nuclear transfer (SCNT) and parthenogenetic activation (PA), and total cells number of cloned embryos were evaluated. The results were analysed by chi-squared and Kruskal-Wallis test with a P-value 0.05) between control and PM, both for cleavage (78.2% and 76.9%) and blastocyst (35.5% and 29.3%) rates. After SCNT, cleavage rate was also similar (P > 0.05) between control and PM (66% and 51.9%) however, blastocyst rate was lower (P < 0.05) in the PM group than in the control group (7.4% and 30.2%). After 6 h of PM with 100 nM of NPPC, approximately 84.9% of the oocytes remained at GV. No difference was found between control and PM in cleavage (69.2% and 76.1%) and blastocyst rates (37,4% and 35%) after IVP. Similarly, no differences between PM and control groups were observed for cleavage (69.2% and 68.4%) and blastocyst (24.4% and 21.5%) rates. SCNT and PA embryos from control or PM oocytes had similar total cell number. It can be concluded that PM for 6 h with 100 nM NPPC is feasible for cloned embryo production without affecting embryo outcome.

Vascular Tone Regulation Induced by C-Type Natriuretic Peptide: Differences in Endothelium-Dependent and -Independent Mechanisms Involved in Normotensive and Spontaneously Hypertensive Rats.

Given that the role of C-type natriuretic peptide (CNP) in the regulation of vascular tone in hypertensive states is unclear, we hypothesized that impaired response of the nitric oxide system to CNP in spontaneously hypertensive rats (SHR) could affect vascular relaxation induced by the peptide in this model of hypertension, and that other endothelial systems or potassium channels opening could also be involved. We examined the effect of CNP on isolated SHR aortas, and the hindlimb vascular resistance (HVR) in response to CNP administration compared to normotensive rats. Aortas were mounted in an isometric organ bath and contracted with phenylephrine. CNP relaxed arteries in a concentration-dependent manner but was less potent in inducing relaxation in SHR. The action of CNP was diminished by removal of the endothelium, inhibition of nitric oxide synthase by Nω-nitro-L-arginine methyl ester, and inhibition of soluble guanylyl cyclase by 1H-[1,2,4]oxadiazolo[4,3-alpha]quinoxalin-1-one in both groups. In contrast, blockade of cyclooxygenase or subtype 2 bradykinin receptor increased CNP potency only in SHR. In both Wistar and SHR, CNP relaxation was blunted by tetraethylammonium and partially inhibited by BaCl2 and iberiotoxin, indicating that it was due to opening of the Kir and BKCa channels. However, SHR seem to be more sensitive to Kir channel blockade and less sensitive to BKCa channel blockade than normotensive rats. In addition, CNP decreases HVR in Wistar and SHR, but the effect of CNP increasing blood flow was more marked in SHR. We conclude that CNP induces aorta relaxation by activation of the nitric oxide system and opening of potassium channels, but the response to the peptide is impaired in conductance vessel of hypertensive rats.

Effect of kit ligand on natriuretic peptide precursor C and oocyte maturation in cattle.

In vitro maturation (IVM) of oocytes in cattle is inefficient, and there is great interest in the development of approaches to improve maturation and fertilization rates. Intraovarian signalling molecules are being explored as potential additives to IVM media. One such factor is kit ligand (KITL), which stimulates the growth of oocytes. We determined if KITL enhances oocyte maturation in cattle. The two main isoforms of KITL (KITL1 and KITL2) were expressed in bovine cumulus-oocyte complexes (COC), and levels of mRNA increased during FSH-stimulated IVM. The addition of KITL to the culture medium increased the percentage of oocytes that reached meiosis II but did not affect cumulus expansion after 22 h of IVM. Addition of KITL reduced the levels of mRNA encoding natriuretic peptide precursor C (NPPC), a protein that holds oocytes in meiotic arrest, and increased the levels of mRNA encoding YBX2, an oocyte-specific factor involved in meiosis. Removal of the oocyte from the COC resulted in increased KITL mRNA levels and decreased NPPC mRNA levels in cumulus cells, and addition of denuded oocytes reversed these effects. Taken together, our results suggest that KITL enhances bovine oocyte nuclear maturation through a mechanism that involves NPPC, and that the oocyte regulates cumulus expression of KITL mRNA.

Nandrolone decanoate induces cardiac and renal remodeling in female rats, without modification in physiological parameters: The role of ANP system.

UNLABELLED: Anabolic-androgenic steroids are misused, including women, but little is known about the cardiovascular effects of these drugs on females. AIM: Evaluated the effects of nandrolone decanoate (ND), physical exercise and estrogen deficiency on female rats. MAIN METHODS: Female Wistar rats were divided into 8 groups: S and OVX: (SHAM: sham surgery; OVX: ovariectomy, vehicle), SE and OVXE (resistance exercise 5 times a week, vehicle), SD and OVXD (treated with ND, 20 mg/kg/week for 4 weeks); SDE and OVXDE. Treatments were initiated 21 days after surgery. The Bezold­Jarisch reflex was assessed by Phenylbiguanide administration. The right atrium, kidney, and serum were collected for molecular analyses by RT-PCR of atrial natriuretic peptide (ANP), A-type natriuretic peptide receptor (NPR-A) and NPR-C. ELISA assay to estradiol and testosterone concentrations. The gastrocnemius muscle, heart and kidney weights/tibia length were measured.Morphometric analysis of heart was made (H/E) and collagen content of heart and kidney were evaluated using Pirossirius Red. KEY FINDINGS: ND treatment increased ANP expression on atrium and decreased NPR-A expression in kidney. Physical exercise and ovariectomy did not alter this parameter. NPR-C level was reduced in the SDE and OVXDE. Renal and cardiac hypertrophy was observed after ND treatment, with collagen deposition. Plasma estrogen concentrations were reduced and serum testosterone concentrations were increased after ND treatment. SIGNIFICANCE: ANP has an important role in modulating the cardiovascular effects of ND in females. Thismodulating may have occurred by the increasing ANP expression, reducing NPR-A and NPR-C expression levels, and changing sex hormone levels.

Identification of snake bradykinin-potentiating peptides (BPPs)-simile sequences in rat brain--Potential BPP-like precursor protein?

Bradykinin-potentiating peptides (BPPs) from the South American pit viper snake venom were the first natural inhibitors of the human angiotensin I-converting enzyme (ACE) described. The pioneer characterization of the BPPs precursor from the snake venom glands by our group showed for the first time the presence of the C-type natriuretic peptide (CNP) in this same viper precursor protein. The confirmation of the BPP/CNP expression in snake brain regions correlated with neuroendocrine functions stimulated us to pursue the physiological correlates of these vasoactive peptides in mammals. Notably, several snake toxins were shown to have endogenous physiological correlates in mammals. In the present work, we expressed in bacteria the BPPs domain of the snake venom gland precursor protein, and this purified recombinant protein was used to raise specific polyclonal anti-BPPs antibodies. The correspondent single protein band immune-recognized in adult rat brain cytosol was isolated by 2D-SDS/PAGE and/or HPLC, before characterization by MS fingerprint analysis, which identified this protein as superoxide dismutase (SOD, EC 1.15.1.1), a classically known enzyme with antioxidant activity and important roles in the blood pressure modulation. In silico analysis showed the exposition of the BPP-like peptide sequences on the surface of the 3D structure of rat SOD. These peptides were chemically synthesized to show the BPP-like biological activities in ex vivo and in vivo pharmacological bioassays. Taken together, our data suggest that SOD protein have the potential to be a source for putative BPP-like bioactive peptides, which once released may contribute to the blood pressure control in mammals.

Total peripheral vascular resistance, cardiac output, and plasma C-type natriuretic Peptide level in children with postural tachycardia syndrome.

OBJECTIVE: To investigate the total peripheral vascular resistance (TPVR), cardiac output (CO), and plasma C-type natriuretic peptide (CNP) levels in children with postural tachycardia syndrome (POTS) during supine, upright, and return to supine. STUDY DESIGN: Twenty-nine children with POTS, aged 12 ± 3 years, were recruited, and 32 healthy children, aged 11 ± 2 years, served as controls. Heart rate (HR), blood pressure, TPVR, and CO were continuously monitored with Finapres Medical System, and plasma CNP levels were detected with Sandwich immunoluminescence assay. RESULTS: In children with POTS, upright TPVR and CO were significantly lower than those in supine position, and they rose again when they returned to supine position. However, in healthy control patients, both TPVR and CO did not change during supine, upright, and supine again positions. Also, in the supine position, there was no significant difference in TPVR and CO between POTS children and control subjects (P > .05). When upright, however, TPVR and CO in children with POTS were significantly lower than those of controls. Plasma CNP levels were significantly greater in children with POTS than that of controls (32.8 ± 9.7 vs 24.2 ± 8.4 [pg/mL], P < .01), and symptom scores and ΔHR positively correlated with plasma CNP levels in children with POTS (symptom scores: r = 0.490, P < .01; ΔHR: r = 0.508, P < .001), but CO negatively correlated with plasma CNP levels (r = -0.446, P < .01). CONCLUSION: Reduced TPVR and CO associated with the elevated plasma CNP might be involved in the pathogenesis of POTS.

Mutações em heterozigose no gene do receptor tipo B dos peptídeos natriuréticos (NPR2) são causa de baixa estatura inicialmente classificada como idiopática / Heterozygous mutations in natriuretic peptide receptor-B gene (NPR2) are cause of short stature initially classified as idiopathic

Nos últimos anos, o sistema do peptídeo natriurético do tipo C (CNP) e seu receptor (NPR-B) foi apontado como um importante regulador do processo de ossificação endocondral. Vários estudos em animais evidenciam o seu papel de estímulo à proliferação e diferenciação de condrócitos e secreção de matriz extracelular. Mutações bialélicas com perda de função do gene do NPR-B (NPR2) levam a uma doença denominada displasia acromesomélica do tipo Maroteaux (AMDM), uma displasia esquelética caracterizada por baixa estatura extrema. Observa-se que familiares de pacientes com AMDM carreadores de mutação no NPR2 têm estatura abaixo da média da população a qual pertencem, sugerindo um papel de mutações em heterozigose do NPR2 como causadoras de baixa estatura idiopática (BEI). Os objetivos deste estudo foram avaliar a presença de mutações no gene NPR2 em um grupo de pacientes com BEI e correlacionar os achados moleculares com o fenótipo dos pacientes e familiares. A região codificadora do gene NPR2 foi sequenciada pelo método de Sanger em 60 pacientes com diagnóstico de BEI. Foram identificadas cinco diferentes variantes alélicas missense em heterozigose no NPR2, cada uma em um único paciente. Essas variantes foram submetidas à análise funcional in vitro para avaliação da atividade da guanililciclase e microscopia confocal para localização intracelular dos receptores NPR-B. As variantes c.226T > C / p.Ser76Pro, c.788G > C / p.Arg263Pro e c.2455C > T / p.Arg819Cys segregam com o fenótipo de baixa estatura dentro das famílias e determinam um prejuízo funcional ao NPR-B. As três variantes geram proteínas que exercem efeito dominante negativo e os receptores NPR-B com as mutações p.Ser76Pro e p.Arg263Pro não se localizam na membrana celular. As variantes c.491C > G / p.Ala164Gly e c.1636A > T / p.Asn546Tyr não segregam com o fenótipo de baixa estatura nas famílias e não se evidenciou um efeito dominante negativo. O escore-Z da altura dos indivíduos carreadores das variantes...

Over the past several years, C-type natriuretic peptide (CNP) and its receptor (NPR-B) system has emerged as an important regulator of endochondral bone growth. Animal models showed a CNP/NPR-B role in promoting chondrocyte proliferation and differentiation and matrix synthesis. Biallelic loss-of-function mutations in NPR-B gene (NPR2) cause acromesomelic dysplasia type Maroteux (AMDM), a skeletal dysplasia with extreme short stature. Relatives of patients with AMDM, heterozygous for NPR2 mutations, were noted to be shorter than expected for their population of origin, suggesting that heterozygous mutations in NPR2 could be a cause of idiopathic short stature (ISS). The objective of this study was to investigate the presence of NPR2 mutations in a group of patients with ISS and to correlate molecular findings with phenotype. The NPR2 coding region was sequenced by Sanger's method in 60 patients with ISS. Five different heterozygous missense variants in NPR2 were identified in five patients. The functional consequences of those variants were established using in vitro cell-based assay to determine guanylate cyclase activity and confocal microscopy to determine intracellular localization of NPR-B. The variants c.226T > C / p.Ser76Pro, c.788G > C / p.Arg263Pro and c.2455C > T / p.Arg819Cys segregated with short stature phenotype and were functionally deleterious. NPR-B receptors with these three variants have a dominantnegative effect and p.Ser76Pro and p.Arg263Pro NPR-B were not localized in the cell membrane. Cosegregation analysis of the variants c.491C > G / p.Ala164Gly and c.1636A > T / p.Asn546Tyr was inconclusive and they did not have a dominant negative effect. Carriers of functionally deleterious variants have a height SD score that ranged from -4.5 to -1.7. One of these patients and two relatives have disproportionate short stature and one has shortened metacarpal. In conclusion, heterozygous mutations in NPR2 gene are cause of short stature in...

Cardiovascular alterations at different stages of hypertension development during ethanol consumption: time-course of vascular and autonomic changes.

The aim of the present work was to establish a time-course correlation between vascular and autonomic changes that contribute to the development of hypertension during ethanol ingestion in rats. For this, male Wistar rats were subjected to the intake of increasing ethanol concentrations in their drinking water during four weeks. Ethanol effects were investigated at the end of each week. Mild hypertension was already observed at the first week of treatment, and a progressive blood pressure increase was observed along the evaluation period. Increased pressor response to phenylephrine was observed from first to fourth week. α1-Adrenoceptor protein in the mesenteric bed was enhanced at the first week, whereas ß2-adrenoceptor protein in the aorta was reduced after the second week. In the third week, ethanol intake facilitated the depressor response to sodium nitroprusside, whereas in the fourth week it reduced nitrate content in aorta and increased it plasma. The bradycardic component of the baroreflex was impaired, whereas baroreflex tachycardia was enhanced at the third and fourth weeks. AT1A receptor and C-type natriuretic peptide (CNP) mRNAs in the nucleus tractus solitarius were increased at the fourth week. These findings suggest that increased vascular responsiveness to vasoconstrictor agents is possibly a link factor in the development and maintenance of the progressive hypertension induced by ethanol consumption. Additionally, baroreflex changes are possibly mediated by alterations in angiotensinergic mechanisms and CNP content within the brainstem, which contribute to maintaining the hypertensive state in later phases of ethanol ingestion. Facilitated vascular responsiveness to nitric oxide seems to counteract ethanol-induced hypertension.

Vascular relaxation induced by C-type natriuretic peptide involves the ca2+/NO-synthase/NO pathway.

AIMS: C-type natriuretic peptide (CNP) and nitric oxide (NO) are endothelium-derived factors that play important roles in the regulation of vascular tone and arterial blood pressure. We hypothesized that NO produced by the endothelial NO-synthase (NOS-3) contributes to the relaxation induced by CNP in isolated rat aorta via activation of endothelial NPR-C receptor. Therefore, the aim of this study was to investigate the putative contribution of NO through NPR-C activation in the CNP induced relaxation in isolated conductance artery. MAIN METHODS: Concentration-effect curves for CNP were constructed in aortic rings isolated from rats. Confocal microscopy was used to analyze the cytosolic calcium mobilization induced by CNP. The phosphorylation of the residue Ser1177 of NOS was analyzed by Western blot and the expression and localization of NPR-C receptors was analyzed by immunohistochemistry. KEY FINDINGS: CNP was less potent in inducing relaxation in denuded endothelium aortic rings than in intact ones. L-NAME attenuated the potency of CNP and similar results were obtained in the presence of hydroxocobalamin, an intracellular NO0 scavenger. CNP did not change the phosphorylation of Ser1177, the activation site of NOS-3, when compared with control. The addition of CNP produced an increase in [Ca2+]c in endothelial cells and a decrease in [Ca2+]c in vascular smooth muscle cells. The NPR-C-receptors are expressed in endothelial and adventitial rat aortas. SIGNIFICANCE: These results suggest that CNP-induced relaxation in intact aorta isolated from rats involves NO production due to [Ca2+]c increase in endothelial cells possibly through NPR-C activation expressed in these cells. The present study provides a breakthrough in the understanding of the close relationship between the vascular actions of nitric oxide and CNP.